Health/healthcare in Nigeria is a challenge only second in importance to security – citizens/patients are dying from lack of access to care and poor care with health unions adding to this burden rather than solving them. Our health service is failing patients – a real change is needed.
The Nigerian national health system is like a football club with excellent players but lacking a team to score goals – Nigeria missed the Millennium Development Goals (MDGs) and healthcare unions seem bent on sustaining these loosing ways by engaging in inter-professional battles – own goals! These crises are more than own goals or arrogance versus rivalries (by many commentators), they constitute the greatest threat to patient safety in Nigeria.
Some have caricatured this as “like army of a nation that would not train or work with their naval counterparts and navy pilots that would not co-operate with their air force colleagues for emergency airlift of the wounded and critical supplies unless they are given air force grades” – this is over simplistic and unhelpful and managers must resist the temptation to accept the above narrative, rather, they should ask two basic questions – first, why does this scenario not occur in the military, second, why would perfectly sane professionals behave so irrationally?
The answers would be revealing, first, critical thinking and strategic planning were hugely invested to determine and develop a suitable military structure at independence, this made provisions for a Joint Chief or CDS (“bridge maker”) to build and maintain effective communication between the various arms headed by a chief (from among the ranks), which facilitates rapport, good relationships that enable officers and men (from various forces) to engage in joint training and working – a very effective system. For the health service, there was little attention to strategic planning at independence, the focus was narrow – to build hospitals and train Nigerian doctors (who would develop their system for their nation).
Secondly, because the health service was left in the hands of doctors to develop for patients and for all other professions, no serious thought has actually gone into proper team building – being a doctor/the leader or being similarly referred to as a doctor became the focus of many professionals rather than the needs of patients, this led in large part, to the poor judgement that occasioned the rejection of Prof Dora Nkem Akunyili (Pharmacist) and transformational DG, NAFDAC by the NMA in 2008 from taking up the health ministerial portfolio.
This rejection caused utter disillusion of non-doctors in the service and became a major catalyst for the formation of rival unions, the drive to acquire doctors’ titles (not for patient care but for parity of esteem) and the big divide that has become filled with irrationality. Arrogance is detestable, so is irrationality, because understanding the cause of irrational behaviour does not make irrationality rational – both sides need to grow up.
Are these challenges beyond remedy? No, but sustainable solutions will require re-design and re-ordering of priorities from personalities to Patients and from silos to Safety, to be achieved through Patient Charter (Healthcare constitution), the Duty of candour and transformative leadership that will be more reflective and responsive to all parties (“bridge maker” role).
UberHealth, a public/private partnership initiative (PPI) where co-located partners/contractors are delivering some services, is another element of the proposed new system. In this system, partners/contractors will be directly responsible for their staff leaving the government to focus on funding and managing healthcare rather than managing unions’ crises.
If the UberHealth system is implemented, staff under direct government employment shall operate in a new paradigm – Patient First, which shall have mechanisms such as Joint clinical governance programs, Multi-Disciplinary Team meetings (MDTs) and clinical excellence awards weighted in favour of joint (multi-professional) quality improvement projects to encourage professionals to develop in effective teams rather than silos.
There will be better opportunities for all groups – consultant posts in community pharmacy, community midwifery, district/community Nurse, community laboratory services or as director of community maternal health, paediatric and primary care services and earn more (with contributions from primary employer 85 per cent; Local government being responsible for 25 per cent and the state government, 10 per cent) – with this simple strategy, non-doctors attain the consultant status they want but at locations where patients’ needs are greatest, likewise consultants in key specialties like maternal, child health and primary care get enhanced roles, responsibilities and accountability that will radically change maternal mortality discourse and outcomes from statistics for political and academic football to the responsibility of a named consultant/medical director – there is a difference between a person being asked why are your children starving and why is there hunger around? Managers must not be hasty in dismissing concerns, no matter how bizarre things first sound or look, there is always a way where there is a will.
Sustainable management of the Nigerian health system, requires a strategy that puts patients at the heart of care not strategies to put out fires which have never worked. The Patient Charter, the duty of candour and transformational leadership system that reflect the needs of patients and aspirations of all staff, will be essential as well as consideration of UBERHealth system (for selected areas)– this is not rocket science.
How many more have to die before this system that has little concern about patients’ suffering and deaths is changed? Patient Safety Africa stands ready to support Nigeria.
Isemede, director, Patient Safety Africa, can be reached at firstname.lastname@example.org
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